Most terminal cancer patients hope to die at home – yet only 1 in 4 does

Published on Tuesday 28 April 2009 22:59

ONLY a quarter of cancer patients in Scotland die in their own home, despite efforts of campaigners to give them that option, according to figures released yesterday.

About half of the 75,000 people who died from cancer between 2003 and 2007 died in NHS acute-care hospitals while only one in four died at home.

Approximately 17 per cent of cancer patients died in hospices.

The Place of Death from Cancer report, issued by NHS Scotland, is the first to specify where patients die.

It shows the overall pattern has remained the same for the past decade.

Campaigners say that while there are many excellent examples of palliative care services in Scotland, inequality of access remains a serious problem.

Problems include uneven access to services and support, lack of support for carers, lack of choice in end-of-life care, poor communication between health professionals and people affected by cancer.

David Oxenham, medical director at the Marie Curie Hospice in Edinburgh, said: "This report is extremely well timed as it provides a very clear guide to the Scottish Government and NHS Scotland about the type and location of palliative care that is required for cancer patients through the implementation of the Living and Dying Well Action Plan.

"Our own research shows about two thirds of people would want to be cared for at home if they were terminally ill, with a sizeable minority opting for hospice care.

"However, as this report continues to reflect, more than 50 per cent of cancer deaths in Scotland still occur in hospital, the place people say they would least like to be."

He added: "We hope this report will better inform the services required in each NHS Health Board and more people will be able to choose the place of death that they wish.

"As a leader in palliative care provision, we continue to work with the government and all other partners to ensure patients' and carers' needs are identified and assessed to ensure that the appropriate care is available across all settings, wherever they live in Scotland."

Dr Oxenham said that it was important for doctors to develop a care plan with cancer patients and their families.

"The most important question to ask a cancer patient is 'if you were so ill you weren't going to get better what would you want?'

"Ideally this would be at home but sometimes something sudden happens and they need to be admitted to hospital.

"If you know that a patient and their family have made clear decisions then an NHS 24 doctor knows what the plan is and can work with them rather than deal with them as he or she would another 99 cases."

Elspeth Atkinson, Macmillan Cancer Support's director for Scotland, said: "The recommendations outlined in the Scottish Government's national action plan Living and Dying Well, which aims to ensure that palliative and end of life care needs are recognised in all care settings, should enable more patients to choose their preferred place of death and for their wishes to be respected.

"However, as most end of life treatment and care is delivered across local health, social care and voluntary sector services, co-ordination of the multi- disciplinary teams is essential."

Daily aspirin could help over-40s keep killer disease at bay

PEOPLE in their 40s could reduce their risk of cancer in later life with a regular dose of aspirin, it is claimed today.

Taking aspirin for at least ten years before cancers normally develop would maximise the effect, scientists at the charity Cancer Research UK said.

They had reviewed evidence from several dozen studies involving more than 50,000 participants. Previous research suggested people taking aspirin were less likely to develop bowel, breast and possibly other cancers including prostate.

Aspirin blocks the effects of enzymes, proteins that help trigger inflammation and are associated with a number of types of cancer.

Doctors tend to advise against healthy people taking aspirin in the long term because it can cause bleeding in the gut and stomach ulcers.

But the researchers said that common cancers tended to develop after the age of 60, which is when aspirin is most likely to have bad side effects.

Professor Jack Cuzick, from the Cancer Research UK Centre for Epidemiology at Queen Mary, University of London, said: "Taking aspirin regularly in your mid-40s could maximise the effect this drug has on preventing cancer."

He said more research was needed before doctors could recommend regular use of aspirin for cancer prevention.